Florence APBI Planning

[dieABRdie]

Having never done this before and being the first to offer it in our group I really am not sure what I should be pushing for. I used constraints from this protocol:

Accelerated Partial Breast Irradiation Using Intensity Modulated Radiotherapy Versus Whole Breast Irradiation - Full Text View - ClinicalTrials.gov

My dosimetrist gave me a static IMRT plan which meets all constraints except the uninvolved breast of 1Gy max, but its only 1.7cc getting over 1Gy to max of 10Gy.

Any comments from those who have done this would be appreciated.

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[deleted969641]

I've done this a lot. Planned just like in trial, delivered QOD. Everyone has done great except one lady who still had a beet-red skin reaction over the treated partial breast at one month post-EOT. So I counsel patients now about the possibility of delayed acute skin reaction.

 

[BobbyHeenan]

I do this regimen quite a bit. Had FANTASTIC tolerance and patient satisfaction. Like Turaco says some patients do get delayed skin reaction, so always counsel that redness may lag behind a week or two. I haven't seen it linger past 4-6 weeks though.

With regard to treatment planning, I too follow the guidelines in the trial. However, you will see in the publications that constraints had some wiggle room with clinical discretion.

I don't think slightly going over a contralateral breast dose in a (for instance) 65 year old female is a problem.

 

[evilbooyaa]

Having never done this before and being the first to offer it in our group I really am not sure what I should be pushing for. I used constraints from this protocol:

Accelerated Partial Breast Irradiation Using Intensity Modulated Radiotherapy Versus Whole Breast Irradiation - Full Text View - ClinicalTrials.gov

My dosimetrist gave me a static IMRT plan which meets all constraints except the uninvolved breast of 1Gy max, but its only 1.7cc getting over 1Gy to max of 10Gy.

Any comments from those who have done this would be appreciated.

I usually shoot for less than what the protocol allowed in terms of soft constraints, but do allow up to the protocol constraints as hard constraints.

Except for contralateral breast, which I don't fixate on - the goal is to make sure it's contoured and as an OAR, but if it's a medial tumor, some dose to contralateral breast is OK.

There is some patient selection involved, at least in my practice - patients with small breasts and/or large seromas I sometimes pivot to just doing WBI. But I do routinely offer it for patients appropriate for PBI.

 

[RadOncDoc21]

Seems more convenient to the patients and staff compared to traditional APBI.

 

[BobbyHeenan]

I usually shoot for less than what the protocol allowed in terms of soft constraints, but do allow up to the protocol constraints as hard constraints.

Except for contralateral breast, which I don't fixate on - the goal is to make sure it's contoured and as an OAR, but if it's a medial tumor, some dose to contralateral breast is OK.

There is some patient selection involved, at least in my practice - patients with small breasts and/or large seromas I sometimes pivot to just doing WBI. But I do routinely offer it for patients appropriate for PBI.

Yes. At times that 50% of the breast getting less than 15 Gy (I think that's it off the top of head) constraint can be tough on a small cup size patient with a big seroma.

Sometimes I pivot to WBI. If older patient I"ve done 26 Gy in 5 for those.

 

[dieABRdie]

Thanks all for the advice. Was actually able to meet all constraints. I could certainly see doing a lot more of this in the future.